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Tian K, Lee HY, Lim HB, Chan YL, Chong AH, Rama Chandran S, Gardner DSL. Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review. AACE Clin Case Rep 2021; 7:346-349. [PMID: 34765729 PMCID: PMC8573278 DOI: 10.1016/j.aace.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/09/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Insulin allergy, although uncommon, poses a significant challenge in those with type 1 diabetes mellitus (T1D) as insulin replacement is a necessity. Our objective is to describe a patient in whom rapid desensitization to insulin aspart was achieved using an insulin pump. Methods A 40-year-old woman with newly diagnosed T1D developed pruritic wheals over the abdomen after being injected with insulin glargine U-300 (Toujeo) and insulin aspart. Type 1 insulin hypersensitivity was confirmed through intradermal testing and positive insulin-specific immunoglobulin E levels. Result The patient underwent rapid desensitization with an insulin pump. Half the anticipated daily basal requirement was initially subcutaneously administered before initiating low-dose insulin via the pump (0.000025 units/h) and increasing the dose every 30 minutes to reach her basal requirements within 5 hours. Subsequent larger bolus insulin doses did not produce any local or anaphylactic reactions. No pretreatment with corticosteroids or antihistamines was provided. Conclusion Previous protocols for insulin desensitization span over days and often involve routine premedication. The case we presented suggests that insulin desensitization can be achieved over several hours using an insulin pump. A subcutaneous basal insulin cover should be provided prior to desensitization to avoid hyperglycemia necessitating an insulin bolus. Routine premedication may not always be necessary depending on reaction severity.
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Affiliation(s)
- Kristy Tian
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Huee Boon Lim
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Yoke Ling Chan
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ai Heong Chong
- Department of Endocrinology, Singapore General Hospital, Singapore
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2
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Fast simultaneous quantification of gabapentin and cetirizine in cell lysates by means of HPLC-MS/MS. J Pharm Biomed Anal 2020; 184:113172. [DOI: 10.1016/j.jpba.2020.113172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 11/18/2022]
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3
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Badik J, Chen J, Letvak K, So TY. Hypersensitivity Reaction to Insulin Glargine and Insulin Detemir in a Pediatric Patient: A Case Report. J Pediatr Pharmacol Ther 2016; 21:85-91. [PMID: 26997933 DOI: 10.5863/1551-6776-21.1.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Allergy to human insulin or its analogs is rare, but it is still a significant issue in current diabetes care. Allergic reactions can range from localized injection site reactions to generalized anaphylaxis, and they can be caused by excipients or the insulin molecules themselves. We presented a case of a 14-year-old male patient with generalized allergic reactions to insulin glargine and insulin detemir. The patient was successfully managed by being switched to a continuous subcutaneous insulin infusion with insulin aspart. Allergic reactions to insulin detemir and insulin glargine have both been well described, with insulin detemir allergy appearing to be more common. There are several potential mechanisms for insulin allergy, and immunologic characteristics vary among different insulin analogs. After confirming insulin allergy in practice, management involves treating symptoms and switching insulin preparations. This is the first documented case of allergies to both insulin glargine and insulin detemir in a pediatric patient. Exact mechanism of insulin allergy is unknown, and management strategies must be individualized for each patient.
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Affiliation(s)
- Jennifer Badik
- Department of Pediatric Endocrinology, Cone Health Pediatric Sub-Specialists of Greensboro, Greensboro, North Carolina
| | - Jimmy Chen
- Medical Student, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kira Letvak
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Tsz-Yin So
- Department of Pharmacy, Moses H. Cone Hospital, Greensboro, North Carolina
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4
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Lavergne SN, Fosset FTJ, Kennedy P, Refsal KR. Potential cutaneous hypersensitivity reaction to an inactive ingredient of thyroid hormone supplements in a dog. Vet Dermatol 2015; 27:53-e16. [PMID: 26748887 DOI: 10.1111/vde.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although discussions about allergic reactions to thyroid supplements abound on professional forums, there is almost no information in the literature on these specific idiosyncratic drug reactions. ANIMAL A dog with a history of hypothyroidism-associated weight gain and mild lethargy was prescribed levothyroxine tablets (0.018 mg/kg twice daily). After 19 days the dog developed a severe skin condition that was responsive to levothyroxine withdrawal, and antibiotic and glucocorticoid therapy. Three weeks later a different levothyroxine tablet was prescribed. Within 48 h the dog developed a more severe cutaneous reaction that resolved with drug discontinuation and appropriate topical care. OBJECTIVES To confirm a possible hypersensitivity reaction and identify its chemical target. METHODS AND RESULTS The two prescribed levothyroxine formulations shared two inactive ingredients: magnesium stearate and polyvinylpyrrolidone. Nine months after discontinuation of thyroid supplement, a formulation without either of these two compounds was used for a second re-challenge. There was no recurrence of the drug reaction and after 1.5 years of treatment the dog remains normal. CONCLUSIONS AND CLINICAL IMPORTANCE These elements strongly suggest that this dog had an idiosyncratic reaction (likely immune-mediated) against one or both inactive ingredients in the first two formulations of levothyroxine. We are not aware of any previous confirmed delayed hypersensitivity to a thyroid supplement in a dog with the likely chemical trigger being an inactive ingredient rather than the therapeutic agent itself. We hope that this case will raise awareness about allergic reactions to thyroid supplements and allergic reactions to inactive formulation components.
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Affiliation(s)
- Sidonie N Lavergne
- Department of Comparative Biosciences, University of Illinois-Urbana-Champaign, College of Veterinary Medicine, 2001 S Lincoln Ave, Urbana, IL, 61802, USA
| | - Fabrice T J Fosset
- Department of Comparative Biosciences, University of Illinois-Urbana-Champaign, College of Veterinary Medicine, 2001 S Lincoln Ave, Urbana, IL, 61802, USA
| | - Peter Kennedy
- Northern Illinois Animal and Bird Hospital, 3202 Northwest Hwy, Cary, IL, 60013, USA
| | - Kent R Refsal
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Road, Lansing, MI, 48910-8104, USA
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5
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Hasselmann C, Pecquet C, Bismuth E, Raverdy C, Sola-Gazagnes A, Lobut JB, Carel JC, Tubiana-Rufi N. Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy. DIABETES & METABOLISM 2012. [PMID: 23206896 DOI: 10.1016/j.diabet.2012.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM Insulin allergy is a rare but serious and challenging condition in patients with type 1 diabetes (T1D). This is a case report of an 8-year-old boy with T1D and an allergy to insulin. CASE REPORT Three months after being diagnosed with T1D, the patient developed progressive skin reactions to insulin, characterized by small 1.5-cm pruritic wheals at injection sites that persisted for several days. Seven months after diagnosis, he experienced two episodes of generalized urticaria with systemic symptoms that were seen within a few seconds of insulin injection. Examination revealed lipoatrophy of the thighs. Intradermal skin tests were positive for protamine, glargine and lispro. The patient was started on a continuous subcutaneous insulin infusion (CSII) tolerance induction protocol, consisting of a very low basal rate that was progressively increased, with the first bolus given under medical supervision, and was well tolerated for 4 months. After this period of time, the skin wheals reappeared, localized to the infusion sites, but without urticaria or any other generalized reactions. Intradermal skin tests were repeated and were again positive. Serum insulin-specific IgE measured 30 months after the first allergic reactions were positive. After 3 years, pump therapy is ongoing and blood glucose control has remained relatively good (HbA1c 7.6%). CONCLUSION In T1D children with insulin allergy, CSII can successfully be used to both induce insulin tolerance and allow diabetes insulin therapy, although insulin desensitization cannot always be fully achieved. The induction protocol was easily manageable partly due to the "honeymoon" period that the patient was still in, but it should nonetheless be used even when the patient has higher insulin requirements.
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Affiliation(s)
- C Hasselmann
- Department of Pediatric Endocrinology and Diabetology, Robert Debré Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
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6
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Abstract
Diabetes mellitus is the most common endocrine disorder with continuously increasing prevalence. Blood vessels, nerves, eyes, kidneys and skin are affected, which causes both an enormous financial burden and a reduced quality of life of the affected patients. Long-standing diabetes may impair skin homeostasis resulting in skin manifestations in at least one third of all diabetics. The skin involvement may be the first presenting sign of diabetes, thus the respective skin signs should lead to diabetes focused diagnostic. Besides, the skin signs may be considered as a marker for the course of the disease or for the success of therapeutic interventions.
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Affiliation(s)
- B Behm
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
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7
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8
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Akinci B, Yener S, Bayraktar F, Yesil S. Allergic reactions to human insulin: a review of current knowledge and treatment options. Endocrine 2010; 37:33-9. [PMID: 19876775 DOI: 10.1007/s12020-009-9256-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 10/11/2009] [Indexed: 01/29/2023]
Abstract
Although the incidence of insulin allergy decreased after the introduction of recombinant human insulin preparations, it is still a major problem which may be life-threatening in some cases. In this article, we attempted to review current knowledge concerning allergic reactions to human insulin and discuss the available treatment options of insulin allergy.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology of Metabolism, Department of Internal Medicine, Dokuz Eylul University Medical School, Inciralti, 35340 Izmir, Turkey.
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9
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Jaeger C, Winter S, Eckhard M, Hardt P, Brendel MD, Bretzel RG. Binding characteristics and crossreactivity of insulin autoantibodies and insulin antibodies directed to three different insulin molecules. Acta Diabetol 2008; 45:191-4. [PMID: 18493700 DOI: 10.1007/s00592-008-0041-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 04/22/2008] [Indexed: 11/28/2022]
Abstract
To evaluate ex vivo/in vitro the binding and dissociation characteristics and the level of crossreactivity of insulin antibodies and insulin autoantibodies directed to three different insulin molecules (human, bovine and porcine insulin). In this study sera from 17 diabetic patients were included, who were exclusively treated with s.c. human insulin, but presenting with severe insulin antibody mediated, immunological insulin resistance (i.e., insulin antibodies, IA). In addition, we included serum from one female patient, previously diagnosed with insulin autoimmune syndrome (no exposure to exogenous insulin treatment, i.e., insulin autoantibodies, IAA). Antibody concentrations and a binding/dissociation analysis was performed by using J(125)-labelled (position: A-14) human, porcine and bovine insulin according to the protocol described recently. In the patient with insulin autoimmune syndrome (IAA) we observed total crossreactivity between human, bovine and porcine insulin. By contrast, in the group of s.c. insulin treated diabetic patients with antibody-mediated insulin resistance (IA) we detected only partial crossreactivity. In these patients, there was a significantly higher level in the inital insulin binding (P < 0.05) directed to human insulin (median: 34%, IQR: 21.0-62.0), compared to porcine (median: 29.5%, IQR: 18.3-61.0) and bovine insulin (29%, IQR: 20.3-61.5), respectively. Here, we demonstrate different binding characteristics between IAA and IA, suggesting different epitope specificities. The observation of a significantly lower insulin binding to the "natural insulin analogs" (bovine and porcine insulin) compared to human insulin in the IA-group is in support of the concept that insulin analogs are eventually less immunogenic.
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Affiliation(s)
- C Jaeger
- II. Medical Clinic, Main-Taunus Hospitals GmbH, Academic Teaching Hospital of Frankfurt University, Kronberger Strasse 36, 65812, Bad Soden a.Ts, Germany.
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10
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Neville KA, Verge CF, Wainstein BK, Woodhead HJ, Ziegler JB, Walker JL. Insulin allergy desensitization with simultaneous intravenous insulin and continuous subcutaneous insulin infusion. Pediatr Diabetes 2008; 9:420-2. [PMID: 18775000 DOI: 10.1111/j.1399-5448.2008.00348.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Persistent 'IgE-mediated' insulin allergy (type 1 allergy) (1), unresponsive to changes in insulin type or the use of antihistamines, necessitates desensitization. A number of case reports (2-7) and recent reviews (8, 9) have demonstrated that desensitization can be achieved with continuous subcutaneous insulin infusion (CSII), but in type 1 diabetes mellitus, the need to slowly increase insulin dose from sub-therapeutic levels competes with the need for glycaemic control and suppression of ketogenesis. Tolerance to intravenous (IV) insulin despite persistent life-threatening allergic reactions to subcutaneous human insulin (bolus or CSII) has been recently described (10). We present the cases of two unrelated 9-yr-old boys with persistent generalized urticarial reactions to subcutaneous injections of all available insulin types, despite treatment with oral antihistamines. After failed rapid desensitization to insulin delivered by either subcutaneous injection or CSII, the concurrent use of IV insulin allowed desensitization to CSII over 5-6 d.
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Affiliation(s)
- Kristen A Neville
- Department of Endocrinology, Sydney Children's Hospital, New South Wales, Australia.
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11
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Conwell LS, Pope E, Artiles AM, Mohanta A, Daneman A, Daneman D. Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr 2008; 152:622-8. [PMID: 18410763 DOI: 10.1016/j.jpeds.2007.10.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/30/2007] [Accepted: 10/04/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To describe the dermatological changes associated with continuous subcutaneous insulin infusion (CSII) therapy in youth with type 1 diabetes mellitus (T1D). To assess their association with duration of CSII, age, adiposity, HbA1(c), insulin dose, insulin brand, infusion set or site. STUDY DESIGN We conducted a cross-sectional study of 50 consecutive patients with T1D who were using CSII for >6 months (26 female; age, 13.3 +/- 3.5 years [mean +/- SD]; CSII duration, 2.8 +/- 1.7 years; HbA1(c), 7.7% +/- 1.1%). A grading scale was devised. Ultrasound scanning was performed in 8 subjects. RESULTS The mean (+/-SD) severity score was 6.3 +/- 3.5 (range, 0-14; maximum possible, 69). Most common were scars <3 mm diameter (94%), erythema not associated with nodules (66%), subcutaneous nodules (62%), and lipohypertrophy (42%). There was a significant negative correlation between severity score and body mass index z-score (r = -0.3, P = .039), but no correlation with HbA1(c), insulin brand or site. Infusion sets inserted at 90 degrees were associated with lower scores (P = .03). Less than 5% of patients and parents considered stopping CSII because of skin concerns. Ultrasound scanning results of CSII sites revealed mild increased echogenicity of the dermis and hypodermis. CONCLUSIONS Dermatological changes were frequent, with increased severity associated with lower adiposity. These complications were not associated with glycemic control, nor did they prompt most to consider stopping CSII.
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Affiliation(s)
- Louise S Conwell
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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12
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Heinzerling L, Raile K, Rochlitz H, Zuberbier T, Worm M. Insulin allergy: clinical manifestations and management strategies. Allergy 2008; 63:148-55. [PMID: 18186805 DOI: 10.1111/j.1398-9995.2007.01567.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Insulin allergy in patients with diabetes mellitus on insulin treatment is a rare condition. It is suspected upon noticing immediate symptoms following insulin injections. The immediate vital implications for the patient call for prompt diagnosis and management of insulin allergy. We review current knowledge and procedures based on four diabetic patients who presented in our clinic. Insulin allergy was suspected as they showed immediate symptoms after insulin injection (urticaria, rash, angioedema, hypotension, dyspnea). A detailed allergologic work-up was performed and adequate therapy was initiated. In three of the four patients, a specific immunotherapy was started whereas in one patient a switch to oral antidiabetics was possible and consequently initiated. By standard prick testing and measurement of specific IgE antibodies, a type 1 IgE-mediated allergy was confirmed. After initiation of insulin immunotherapy, the symptoms completely resolved in two out three of patients and significantly improved in the third patient. The fourth patient was successfully switched to oral antidiabetics. Insulin allergy is a rare but severe condition that calls for immediate allergological work-up. It can be managed well in close cooperation between the diabetologist and the allergologist. Specific immunotherapy is efficient and should be considered.
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Affiliation(s)
- L Heinzerling
- Department of Dermatology and Allergy, Charité Universitätsmedizin, Berlin, Germany
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13
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Radermecker RP, Scheen AJ. Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues. Diabetes Metab Res Rev 2007; 23:348-55. [PMID: 17216593 DOI: 10.1002/dmrr.714] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence but not completely suppressed the occurrence of insulin allergy manifestations. Advances in technologies concerning the mode of delivery of insulin, i.e. continuous subcutaneous insulin infusion (CSII), and the use of insulin analogues, resulting from the alteration in the amino acid sequence of the native insulin molecule, may influence the immunogenicity and antigenicity of native insulin. Instead of increasing allergy reactions, CSII has been reported to represent a successful alternative treatment in diabetic patients presenting local or generalized allergy to insulin or other components (zinc, protamine) of conventional treatment. Most recent reports concern CSII-treated patients using short-acting insulin analogues (essentially insulin lispro), although the precise role of these insulin analogues remains unclear as allergy to them has also been described. Finally, data on antigenicity and immunogenicity of long-acting insulin analogues (glargine, detemir), which may mimic the basal insulin delivery with CSII, remain scarce at present.
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Affiliation(s)
- R P Radermecker
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, University of Liège, B-4000 Liège, Belgium.
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14
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Beltrand J, Guilmin-Crepon S, Castanet M, Peuchmaur M, Czernichow P, Levy-Marchal C. Insulin Allergy and Extensive Lipoatrophy in Child with Type 1 Diabetes. Horm Res Paediatr 2006; 65:253-60. [PMID: 16582568 DOI: 10.1159/000092515] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 01/14/2006] [Indexed: 01/02/2023] Open
Abstract
Insulin allergy and lipoatrophy in type 1 diabetic patients have been previously reported but the mechanisms are not well documented. Here, we report a case emphasizing the role of abnormal local immune reaction associated with cytokine hyper production. The patient is a 7-year-old boy with a familial history of common variable immunodeficiency. Eight months after the diagnosis of type 1 diabetes, he developed signs of insulin allergy expressed as continuously extensive and profound lipoatrophy contrasting with a well-preserved metabolic control. Specific insulin allergy was confirmed by skin prick tests that showed lymphoid activated cells in the subcutaneous tissue at the site of insulin injection. All therapies reported in the literature (antihistaminic, local steroid, change to lispro insulin, immunosuppressive treatment, subcutaneous insulin pump, peritoneal insulin infusion) were not efficient. It is suggested that familial disorders of immune cell functions with abnormal and excessive cytokine production might explain these adverse effects triggered by insulin with severe allergic reactions and lipoatrophy.
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Affiliation(s)
- Jacques Beltrand
- Inserm U 690 'Diabète de l'enfant et développement', Robert Debré Hospital, Paris, France.
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15
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Castéra V, Dutour-Meyer A, Koeppel M, Petitjean C, Darmon P. Systemic allergy to human insulin and its rapid and long acting analogs: successful treatment by continuous subcutaneous insulin lispro infusion. DIABETES & METABOLISM 2006; 31:391-400. [PMID: 16369203 DOI: 10.1016/s1262-3636(07)70210-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Since the introduction of highly purified human recombinant insulin, allergy to insulin has become a very rare clinical situation, encountered in less than 1% of patients. It results in potentially life-threatening immediate or delayed, local and general manifestations. Different treatments of unequal efficiency have been proposed, the use of insulin analogs showing benefits in certain situations. We report the case of a type 2 diabetic patient who presented local reactions and then an anaphylactic shock after the introduction of insulin analog premixes. Intra-dermal reactions performed with porcine, human and insulin analogs preparations (aspart, lispro, glargine) were all positive, as well as the specific anti-insulin IgE measurement. Because we could not achieve normoglycaemia with maximal oral treatment and low caloric diet, we decided to attempt a desensitisation by continuous subcutaneous infusion of insulin lispro, since the lowest skin reaction was obtained with this insulin. We were able to induce a tolerance, by means of very low basal rate, very slowly increased, without any boluses, and maintaining antihistamine therapy. Six months later, the patient remains free of any symptom and has achieved a quite good glycaemic control. We describe for the first time a case of allergy to human insulin and to all available rapid and long acting analogs. We show the interest of a treatment with CSII of analogs in order to induce tolerance.
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Affiliation(s)
- V Castéra
- Department of Endocrinology, Hôpital Nord, Chemin des Bourrely, F-13015 Marseille, France.
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16
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Matheu V, Perez E, Hernández M, Díaz E, Darias R, González A, García JC, Sánchez I, Feliciano L, Caballero A, de la Torre F. Insulin allergy and resistance successfully treated by desensitisation with Aspart insulin. Clin Mol Allergy 2005; 3:16. [PMID: 16375762 PMCID: PMC1352375 DOI: 10.1186/1476-7961-3-16] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/23/2005] [Indexed: 11/30/2022] Open
Abstract
A 25-year-old, with type I Diabetes Mellitus with a previous diagnosis of Protamine Allergy but not to human Insulin, started to notice anaphylactic reactions inmmediatly after bolus with Insulin. Skin prick and intradermal test were positive to all insulins. Skin tests to other potential allergens resulted negative. Examination after bolus of Human Insulin revealed urticaria. Daily insulin requirement were around 2-2,4 U/Kg/day. Slow desensitisation with Aspart insulin, the insulin with lowest size of skin test, was performed using subcutaneous insulin pump. Six months after the end of desensitisation his daily insulin requirement decreased to 0.8 U/Kg/day and oral corticosteroids are being reduced with no symptoms.
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Affiliation(s)
- Victor Matheu
- Medical Inflammation Research, Lund University, Sweden
| | - Eva Perez
- Allergy, Hospital Universitario NS Candelaria, Spain
| | - Marta Hernández
- Endocrinology Service, Hospital Universitario de Canarias, Spain
| | - Elisa Díaz
- Allergy, Hospital Universitario NS Candelaria, Spain
| | - Ricardo Darias
- Endocrinology, Hospital Universitario NS Candelaria, Spain
| | - Abel González
- Endocrinology, Hospital Universitario NS Candelaria, Spain
| | - Jose C García
- Allergy, Hospital Universitario NS Candelaria, Spain
| | | | - Laura Feliciano
- Dermatology Service, Hospital Universitario NS Candelaria, Spain
| | - Agueda Caballero
- Endocrinology Service, Hospital Universitario de Canarias, Spain
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17
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Affiliation(s)
- L Fernández
- Allergy Unit, Hospital Sierrallana, Barrio Ganzo s/n, 39300 Torrelavega, Spain
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18
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Sola-Gazagnes A, Pecquet C, Radermecker R, Piétri L, Elgrably F, Slama G, Sélam JL. Successful treatment of insulin allergy in a type 1 diabetic patient by means of constant subcutaneous pump infusion of insulin. Diabetes Care 2003; 26:2961-2. [PMID: 14514615 DOI: 10.2337/diacare.26.10.2961] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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19
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Durand-Gonzalez KN, Guillausseau N, Anciaux ML, Hentschel V, Gayno JP. Allergy to insulin in a woman with gestational diabetes mellitus: transient efficiency of continuous subcutaneous insulin lispro infusion. DIABETES & METABOLISM 2003; 29:432-4. [PMID: 14526273 DOI: 10.1016/s1262-3636(07)70056-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the case of a 31-year-old pregnant woman. She required insulin for the treatment of gestational diabetes from 27 weeks of amenorrhoea to delivery. An allergy to insulin was suspected because she presented with local symptoms at insulin injection sites and a decrease in efficiency of insulin. This diagnostic was confirmed by skin-prick tests. A treatment with subcutaneous continuous lispro insulin analogue infusion was initiated with an oral antihistaminic drug without local reaction. Seven weeks after the initiation of insulin pump, local reactions reappeared. The insulin analogue lispro is not always an alternative in insulin allergy. However, in the case we report, the lack of allergy during a few weeks allowed the birth of a normal infant.
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20
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Richardson T, Kerr D. Skin-related complications of insulin therapy: epidemiology and emerging management strategies. Am J Clin Dermatol 2003; 4:661-7. [PMID: 14507228 DOI: 10.2165/00128071-200304100-00001] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The incidence and prevalence of all types of diabetes mellitus is increasing at an alarming rate. Modern therapy involves greater and earlier use of intensive insulin regimens in order to achieve better control of blood glucose levels and reduce the long-term risks associated with the condition. Insulin therapy is associated with important cutaneous adverse effects, which can affect insulin absorption kinetics causing glycemic excursions above and below target levels for blood glucose. Common complications of subcutaneous insulin injection include lipoatrophy and lipohypertrophy. The development of lipoatrophy may have an immunological basis, predisposed by lipolytic components of certain insulins. Repeated use of the same injection site increases the risk of lipoatrophy--with time, patients learn that these areas are relatively pain free and continue to use them. However, the absorption of insulin from lipoatrophic areas is erratic leading to frequent difficulties in achieving ideal blood glucose control. With the increasing use of modified, rapidly absorbed analog insulins (e.g. insulin lispro, insulin aspart) the incidence of lipoatrophy occurring has decreased over recent years. The likelihood of lipoatrophy can be reduced by regular rotation of injection sites but once developed, practical benefits may be obtained by insulin injection into the edge of the area, co-administration of dexamethasone with insulin, or changing the mode of insulin delivery. Lipohypertrophy is the most common cutaneous complication of insulin therapy. Newer insulins have also reduced its prevalence considerably, although its adverse effect on diabetic control is similar to lipoatrophy through impaired absorption of insulin into the systemic circulation. Experience with liposuction at these sites is limited, although good cosmetic results have been achieved. Local allergic reactions to insulin are usually erythema, pruritus, and induration. These allergic reactions are usually short-lived, and resolve spontaneously within a few weeks. Useful adjuncts to managing allergic reactions include addition of dexamethasone to the insulin injection, desensitization to insulin, or a change in delivery system utilizing insulin pump therapy or potentially inhaled insulins when these become available. The use of insulin pump therapy in managing cutaneous complications of insulin therapy is increasing, but this method itself carries risks of abscess formation and scarring. Fortunately, with improved education of patients these are relatively uncommon. Although many of the cutaneous manifestations are decreasing with the use of newer insulins, they may still influence glycemic control and increase the risk of hypoglycemia as well as have a cosmetic impact on a patient. The introduction of novel therapies and newer delivery systems is likely to reduce the cutaneous problems associated with long-term insulin use.
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Affiliation(s)
- Tristan Richardson
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, UK.
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